ACSM Northwest Mentorship Program Mentor Interest Form
The following questions will allow us to pair you with a suitable mentee or mentees as part of the newly established ACSM Northwest Mentorship Program. There will be a luncheon dedicated to this program at our upcoming Annual Meeting in Bend, OR with ACSM Presidential candidate, Dr. NiCole Keith, as the keynote speaker.
First and Last Name
Current University or Industry Affiliation
What is your job title?
What is your highest degree obtained?
When did you first become a member of ACSM?
This can include membership at the regional or national level.
Will you be attending the upcoming (March 1 & 2) ACSM Northwest Annual Meeting in Bend, OR?
Yes, both days
Yes, but Friday only
Yes, but Saturday only
No, not this year
Have you ever held an ACSM board position?
This can include positions at either the regional or national level.
Are you a Fellow of ACSM?
What are your current research interests?
What level of student would you be most comfortable mentoring?
Please select all that apply
Do you have any additional experiences that may help us pair you with mentees?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service